Open AccessCriteria for the Appropriate Treatment of Osteoporotic Vertebral Compression Fractures
Author(s) -
Giovanni Carlo Anselmetti,
J Bernard,
T. R. Blattert,
Charles Court,
Daniel Fagan,
H. Fransen,
Patrick Fransen,
Tarun Sabharwal,
F. Schils,
Rupert Schupfner,
Mashood Siddiqi,
Herman Stoevelaar,
Christian Kasperk
Publication year - 2013
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2013/16/e519
Subject(s) - medicine , vertebral compression fracture , appropriateness criteria , osteoporotic fracture , appropriate use criteria , multidisciplinary approach , deformity , osteoporosis , physical therapy , surgery , radiology , bone mineral , social science , sociology
Background: The heterogeneity of patients with osteoporotic vertebral compressionfractures (VCF) necessitates a tailored approach of balancing the benefits and limitations ofavailable treatments. Current guidelines are divergent, sometimes contradictory, and ofteninsufficiently detailed to guide practice decisions.Objectives: This study aimed at establishing treatment recommendations at the patientspecific level.Study Design: Using the RAND/UCLA Appropriateness Method (RAM), the appropriatenessof different treatment options for osteoporotic VCFs was assessed.Setting: The assessment was conducted by a European multidisciplinary panel of 12 experts.Methods: The appropriateness of non-surgical management (NSM), vertebroplasty (VP), andballoon kyphoplasty (BKP) was determined for 128 hypothetical patient profiles. These wereunique combinations of clinical factors considered relevant to treatment choice (time sincefracture, MRI findings, impact and evolution of symptoms, spinal deformity, ongoing fractureprocess, and pulmonary dysfunction). After 2 individual rating rounds and plenary meetings,appropriateness statements (appropriate, inappropriate, and uncertain) were calculated for allclinical scenarios.Results: Disagreement dropped from 31% in the first round to 7% in the second round.Appropriateness outcomes showed specific patterns for the 3 treatments. For three-quartersof the profiles, only one treatment was considered appropriate: NSM 25%, VP 6%, andBKP 45%. NSM was usually appropriate in patients with a negative MRI or a positive MRIwithout other unfavorable conditions (poor outcomes for the other variables). VP was usuallyappropriate in patients with a positive MRI, time since fracture ≥ 6 weeks, and no spinaldeformity. BKP was recommended for all patients with an ongoing fracture process, and alsoin most patients with a positive MRI and ≥ 1 other unfavorable factor.Limitations: The prevalence of the patient profiles in daily practice is yet unknown.Conclusion: The panel results may help to support treatment choice in the heterogeneouspopulation of patients with osteoporotic VCF.Key words: Appropriateness criteria, balloon kyphoplasty, non-surgical management,osteoporosis, RAND/UCLA Appropriateness Method, treatment choice, vertebral compressionfractures, vertebroplasty: